Introduction
Clopidogrel + Aspirin is a combination of two drugs, namely Clopidogrel and Aspirin, typically prescribed to reduce the risk of heart attacks, strokes, and death caused by blocked arteries. It is considered a better option than Aspirin alone, as it has been found to reduce the risk of heart attack and stroke in patients with a history of coronary artery disease (CAD).
Uses
Clopidogrel + Aspirin is used for the prevention of heart attacks and strokes caused by blocked arteries. It is also used for the treatment of other conditions like Peripheral Vascular Disease (PVD), Acute Myocardial Infarction (AMI), and Unstable Angina (UA). The drug is also used for the prevention of other ischemic events such as death due to myocardial infarction (MI) and stroke.
Mechanism of Action
Clopidogrel + Aspirin works by inhibiting platelet aggregation, thus preventing the formation of blood clots. Aspirin works by inhibiting the enzyme cyclooxygenase, which is responsible for the production of thromboxane. This prevents thromboxane from binding to platelets and reduces platelet aggregation. Clopidogrel inhibits the enzymatic activity of the adenosine diphosphate (ADP) receptor on the platelets, which helps prevent the platelets from sticking together and forming clots.
How Long Does it Take to Work?
Clopidogrel + Aspirin usually begins to work within two to four hours after taking it. However, it may take up to two weeks for the full effects to take place.
Absorption
Clopidogrel and Aspirin are both rapidly and well absorbed after oral administration. Both drugs are metabolized mainly in the liver. Aspirin is metabolized to acetylsalicylic acid and clopidogrel is metabolized to its active form.
Route of Elimination
Clopidogrel and Aspirin are both eliminated primarily in the urine. Clopidogrel is eliminated mainly as unchanged drug, whereas aspirin is eliminated mainly as its metabolites.
Dosage
The recommended dose of Clopidogrel is 75 mg once daily with or without food. No dosage adjustment is necessary for elderly patients or patients with renal patients. For patients with acute coronary syndrome (unstable angina/non-Q-wave MI), Clopidogrel should be initiated with a single 300 mg loading dose and then continued at 75 mg once daily. Aspirin (75 mg-325 mg once daily) should be initiated and continued in combination with Clopidogrel. In studies it was found that most patients with acute coronary syndrome also received heparin acutely.The usual recommended dosage of Clopidogrel + Aspirin is 75 mg of clopidogrel combined with 81 mg of aspirin once daily. The dose may be increased to 150 mg of clopidogrel combined with 162 mg of aspirin once daily for those with a history of myocardial infarction.
Administration
Clopidogrel + Aspirin should be taken with a full glass of water on an empty stomach. The tablets should not be crushed or chewed before being swallowed.
Side Effects
Common side effects of Clopidogrel + Aspirin are stomach pain, diarrhea, constipation, nausea, vomiting, and heartburn. Serious side effects include bleeding, easy bruising, confusion, irregular heartbeat, dizziness, and swelling.
Toxicity
Overdose of Clopidogrel + Aspirin can be toxic and may cause serious side effects like excessive bleeding, severe headache, fever, rapid heartbeat, chest pain, difficulty breathing, seizures, drowsiness, and confusion.
Precaution
Patients who are taking Clopidogrel + Aspirin should avoid alcohol and other medications that may increase the risk of bleeding. Patients should also be monitored for any signs of bleeding or re-occlusion of blocked arteries.
Interaction
Clopidogrel + Aspirin should not be taken with anticoagulants like warfarin or other drugs like ibuprofen or naproxen that may increase the risk of bleeding. It should also not be taken with antiplatelet drugs like ticlopidine and clopidogrel bisulfate.
Disease Interaction
Clopidogrel + Aspirin may interact with certain diseases including bleeding disorders, liver or kidney disease, and active gastric ulcers.
Drug Interaction
Clopidogrel + Aspirin may interact with certain drugs like heparin, warfarin, and other antiplatelet drugs like clopidogrel bisulfate and ticlopidine.
Food Interactions
Clopidogrel + Aspirin should not be taken with food or food supplements that contain large amounts of vitamin K such as green leafy vegetables, liver, and fortified cereals.
Pregnancy Use
Clopidogrel + Aspirin is not recommended for pregnant women. Aspirin use during the later stages of pregnancy can lead to complications including hemorrhage and premature birth.
Lactation Use
Clopidogrel + Aspirin should be avoided during breast-feeding due to the potential for drug transfer and increased risk of bleeding for the baby.
Acute Overdose
An overdose of Clopidogrel + Aspirin may cause excessive bleeding, ringing in the ears, difficulty breathing, confusion, dizziness, and irregular heartbeat. If an overdose is suspected, seek medical help immediately.
Contraindication
Clopidogrel + Aspirin should not be used in people with a history of ulcers, bleeding disorders, or a known hypersensitivity to either of the drugs.
Use Direction
Clopidogrel + Aspirin should be taken as directed by your doctor or pharmacist. Do not change the dose or stop taking the medication without your doctor’s permission.
Storage Condition
Clopidogrel + Aspirin should be stored at room temperature away from light and moisture. It should be kept out of reach of children and pets.
Volume of Distribution
The volume of distribution for Clopidogrel + Aspirin is 0.48 L/kg, indicating a wide distribution throughout the body.
Half-Life
The half-life of clopidogrel is 5-7 hours and the half-life of aspirin is 15-30 minutes.
Clearance
Clopidogrel has an oral clearance of 32.5ml/min/kg and Aspirin has an oral clearance of 4.2 ml/min/ kg.
